The Department of Emergency Medicine of Froedtert Memorial Lutheran Hospital (FMLH) in collaboration with the Medical College of Wisconsin (MCW), and the Children's Hospital of Wisconsin are submitting this application for consideration to become a Clinical Site Hub (CSH) of the NINDS Emergencies Treatment Trials Network (NETT)(RFA-NS-06-009), to be known as the Milwaukee Clinical Site Hub (MCSH). Implementation of the selected NETT Network protocols will exploit the award-winning models of the Milwaukee County Emergency Medical Services (EMS) System and the nationally recognized Adult and Pediatric Trauma Centers housed at FMLH Adult Emergency Department and the adjoining Children's Hospital of Wisconsin (CHW) Pediatric Emergency Department, located on the MCW campus. Froedtert Memorial Lutheran Hospital, the Froedtert-MCW Stroke and Neurovascular Center, the Children's Hospital of Wisconsin, and the Milwaukee County EMS System will serve as the foundation of the Milwaukee Hub. Eight of the area's 15 affiliated paramedic-receiving community hospitals will serve as clinical spokes to support patient assessment and recruitment in real time and facilitate the dissemination of research results. These hospitals are members of the Milwaukee Emergency Medicine Research Consortium (MEMRC), an experienced and proven research association, distinguished by its long-standing infrastructure to support in- hospital and out-of-hospital research. The Milwaukee HUB will capitalize on its enormous existing research infrastructure to cost-effectively achieve the goals of the NETT to provide clinical leadership, research support, and local neurological expertise; coordinate IRB activities and human subjects protections; enter data, manage contracts, and oversee training activities. The principal investigator and key personnel are committed to actively partnering with the NETT Network and to disseminating the outcomes of the collective activities among community health care providers. The Milwaukee HUB aims to: 1) Leverage our existing infrastructure, established collaborations, and experience in conducting clinical research in the EMS and hospital settings (including exception to informed consent under emergency circumstances) to perform selected NETT clinical trials to enhance the efficient conduct of clinical research in neurological emergencies; 2) Orchestrate the participation of multiple emergency medicine departments and hospitals to expedite patient recruitment in neurological studies; 3) Engage a wide spectrum of investigators from MCW and participating hospitals; 4) Maximize our successful experience and capacity to recruit and retain a broad range of qualified subjects; 5) Cooperate with other NETT Hubs in facilitating the transfer of research; and 6) Coordinate with Network members in developing and testing innovative telemedicine methods involving off-site specialists in the care of neurological disorders in the emergency department. [unreadable] [unreadable] [unreadable]